改良背阔肌肌皮瓣的解剖学研究及临床应用

发布时间：2018-06-19 06:02

本文选题：胸背动脉 + 穿支瓣　；参考：《安徽医科大学》2008年硕士论文

【摘要】： 目的探讨保留胸背神经的胸背动脉穿支皮瓣的解剖学基础及临床应用的效果。方法①选用16具32侧成人躯干标本,对胸背神经、血管进行显微解剖观测;②在1具防腐成人尸体标本上,行胸背动脉穿支皮瓣手术的模拟;③在解剖研究基础上,应用保留部分胸背神经的背阔肌皮瓣或肌皮穿支瓣移植修复肢体和头面部大块皮肤软组织缺损共9例。其中应用胸背动脉内侧支为蒂3例,外侧支为6例。均携带相应的胸背神经分支。结果①背阔肌肌肉及其表面的皮下组织、皮肤是多源性供血,以胸背动脉及其肌皮穿支为主要供血血管,同时还有肋间动脉、腰动脉供血;②从胸背神经一级分支分叉处向近心端至见到内侧支和外侧支之间有神经纤维交织处长度为(25.12±3.19)mm。胸背动脉起始部外径为(2.32±0.15)mm,总干长为(56.75±4.99)mm。胸背神经起始部干径为(2.14±0.29)mm,总干长为(61.22±8.51)mm。胸背神经与胸背动脉之间及一级分支之间的最宽距离是(2.98±0.08)mm。肌皮穿支在肌内斜行距离为(42.78±13.24)mm,肌皮穿支入肌时背阔肌厚度为(4.15±1.24)mm,水平投影距离为(42.55±13.28)mm;③在32侧标本中,随机选择了第一、第二肌皮穿支观察,共64支,血管外径均大于0.5mm;④4例转移皮瓣、5例吻合移植,术后皮瓣完全成活。保留背阔肌的外形良好,肩关节内收、内旋、后伸功能与术前无明显差异。结论①胸背动脉和胸背神经的一级分支可分离切取移植,另一分支功能不受影响;②以胸背动脉肌皮穿支为蒂的肌皮穿支瓣移植,供区病损小;③应用保留胸背神经的部分背阔肌皮瓣移植或带少量肌袖的胸背动脉穿支皮瓣移植,可根据缺损情况随机切取肌肉量,最大限度地保留了背阔肌的功能,是躯体大块组织缺损较理想的修复方法。
[Abstract]:Objective to investigate the anatomical basis and clinical application of dorsal thoracic artery perforator flap preserving thoracic dorsal nerve. Methods 1 A total of 16 adult trunk specimens (32 sides) were selected to observe the microanatomy of thoracic dorsal nerve and blood vessel on 1 embalmed adult cadavers, and the anatomic study was carried out on the basis of anatomic study on the operation of perforating branch flap of thoracic dorsal artery. The latissimus dorsi flap or musculocutaneous perforating branch flap was used to repair large skin and soft tissue defects of limbs and head and face in 9 cases. The medial branch of the dorsal thoracic artery was used as pedicle in 3 cases and the lateral branch in 6 cases. All of them carried the corresponding branches of thoracic dorsal nerve. Results 1latissimus dorsi muscle and its surface subcutaneous tissue, the skin is multi-source blood supply, the thoracic dorsal artery and its musculocutaneous perforating branch as the main blood supply vessel, but also the intercostal artery, the lumbar artery; (2) the length of nerve fibers intertwined between the medial and lateral branches from the first branch of the thoracic dorsal nerve to the proximal end of the heart was 25.12 卤3.19mmm. The external diameter of the starting part of the thoracic dorsal artery was 2.32 卤0.15 mm and the total trunk length was 56.75 卤4.99 mm. The diameter of the initial trunk of the thoracic dorsal nerve was 2.14 卤0.29 mm and the total length of the trunk was 61.22 卤8.51 mm. The widest distance between the dorsal thoracic nerve and the thoracic dorsal artery and the first branch was 2.98 卤0.08mm. The distance of the perforating branches in the muscle was 42.78 卤13.24mm, the thickness of latissimus dorsi was 4.15 卤1.24mm, and the distance of horizontal projection was 42.55 卤13.28mm. The first and second musculocutaneous perforators were randomly selected for observation. The external diameters of the vessels were greater than 0.5 mm in 44 cases and 5 cases were anastomosed and the flap survived completely after operation. The shape of latissimus dorsi was good. There was no significant difference in shoulder adductor, internal rotation and extension function between before and after the preservation of latissimus dorsi. Conclusion (1) the primary branches of the dorsal thoracic artery and the thoracic dorsal nerve can be removed and transplanted separately, and the other branch function is not affected. 2 the graft pedicled with the musculocutaneous perforating branch of the thoracic dorsal artery has little lesion in the donor area. 3Transplantation of partial latissimus dorsi musculocutaneous flap with preservation of thoracic dorsal nerve or transplants of perforating branch of thoracic dorsal artery with a few muscle cuff, muscle quantity can be randomly cut according to the condition of defect, and the function of latissimus dorsi muscle can be preserved to the maximum extent. It is an ideal method for repairing body mass tissue defect.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R322;R622

【参考文献】